Chapter 6.A.2 (or 4.A.2) Incompetent Organ "Donors"

This is an updated version of the Problem: Conceiving a Child to Make Tissue Available for Transplantation

A couple, John and Joanne, have a ten-year-old daughter with leukemia who will almost certainly die within five years without a stem cell transplant.  (Historically, stem cells for transplantation were taken from the donorís bone marrow, but now stem cells can often be retrieved as well from a donorís circulating blood or a newbornís umbilical cord blood.)  With a transplant, there is a 70 percent chance of a long-term survival. Family members and friends have been tested to see if their stem cells are compatible, but none are candidates for transplantation. Despite a nationwide search to find a compatible donor, none has been found. John and Joanne decide to conceive another child in the hope that this child's stem cells will be suitable for transplantation in their daughter. There is a 25 percent chance that a new child will have compatible cells, but the odds can be improved to 100 percent with preimplantation genetic screening.  With this approach, a couple can create embryos through in vitro fertilization.  The embryos can then be tested to see if the new childís stem cells will be compatible with the existing child.  Yury Verlinsky, et al., Preimplantation HLA Testing, 291 JAMA 2079 (2004).  If John and Joanne bear a child, and the child's cells are compatible, then physicians would perform a transplant with stem cells from umbilical cord blood after birth or other stem cells when the new child is older. There is no risk to the child from using its umbilical cord blood; the risk that the child would die from a surgery to remove her marrow is unknown, but probably in the range of 1/25,000 to 1/100,000. The risk of serious complications from using stem cells from circulating blood is also very low.  Should John and Joanne be able to conceive the child and consent to the transplantation?  [This problem is based on the Ayala case, in which a couple conceived a child to serve as a bone marrow donor for their daughter. Diane M. Gianelli, Bearing a Donor? Ethical Concerns Raised Over Having a Baby for Marrow Match, American Medical News, Mar. 2, 1990, at 3.  For further discussion, see Katrien Devolder, Preimplantation HLA Typing: Having Children to Save Our Loved Ones, 31 J. Med. Ethics 582 (2005); Susan M. Wolf, et al., Using Preimplantation Genetic Diagnosis to Create a Stem Cell Donor: Issues, Guidelines & Limits, 31 J.L. Med. & Ethics 327 (2003).]